Yojana Analysis

May 2018

“NUTRITION”

By: Mohit Jindal

About Me
 B. Tech., IIT Bombay
 Appeared in IAS Mains & Interview

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 Email: mohit8jindal@gmail.com
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 What is Nutrition?
• Nutrition is the intake of food, considered in relation to
the body’s dietary needs. - WHO
– Macronutrients: Carbohydrates, Lipids (fats) and Proteins
– Micronutrients: Vitamins and minerals
• Malnutrition
– Under-nutrition
• Macronutrient ↓ => Stunting | Wasting | Underweight
• Micronutrient ↓ => Vitamin A, Iodine, Iron, etc.
– Over-nutrition => Overweight, Obesity, NCDs, etc.
 Discussion via Question
1. Bring out the state of India’s Malnutrition through relevant facts.
2. Discuss in detail the National Nutrition Mission (NNM).
3. How to make National Nutrition Mission a success?
4. What are the challenges in achieving financial inclusion?
5. What steps has government taken to expand health coverage?
6. Discuss the initiatives to boost infrastructure in India.
7. Discuss the steps taken for social inclusion.
Q1. Bring out the state of India’s Malnutrition through relevant
facts.
Undernutrition in Children (0-5 yrs)

Low ht for age Low wt for ht Low wt for age

 Undernutrition in Women & Girls
• Women with Low BMI (15-49 age)
– NFHS-3 (2005-06) = 35.5%
– NFHS-4 (2015-16) = 22.9%
• Anemia in Women (15-49 age)
– NFHS-3 (2005-06) = 55.3%
– NFHS-4 (2015-16) = 53%
 Other important parameters
• Institutional Deliveries
– NFHS-3 (2005-06) = 38%
– NFHS-4 (2015-16) = 80%
• Early initiation of breastfeeding
– NFHS-3 (2005-06) = 23.4%
– NFHS-4 (2015-16) = 41.6%

• Drinking Water & Sanitation

– 2/3rd households have access to an improved source of drinking water
– About 50% of households have access to improved sanitation facilities
 Dual burden of Malnutrition
• India is in the process of nutrition transition,
where the dual burden of malnutrition – i.e.
overnutrition and undernutrition is beginning
• Overweight children (< 5) are fast approaching
the number of children suffering from wasting
– Overweight children (< 5) are increasing most
rapidly in Asia
Q2. Discuss in detail the National Nutrition Mission.
 Existing programs
1. Integrated Child Development Services
2. National Health Mission- including RMNCH + A
3. Janani Suraksha Yojana + Matritva Sahyog Yojana
4. Swachh Bharat Mission
5. National Rural Drinking Water Programme
6. SABLA for adolescent girls
7. Mid Day Meals Scheme
8. Targeted Public Distribution System
9. National Food Security Mission
10. Mahatma Gandhi NREGS
11. National Rural Livelihood Mission
 Need
• Current efforts were fragmented
• Lacked target-based approach
• Needed proper plan of action
• Behavioral change ignored
 Aim
• Improve nutritional status of:
– Children (0-6 yrs)
– Adolescent Girls
– Pregnant Women and Lactating Mothers
 Targets
• Targeted reduction:
– Stunting = 2% per annum (25% by 2022)
– Undernutrition = 2% per annum
– Anemia (children + women) = 3% per annum
– Low birth weight = 2% per annum
 Implementation Strategy
• Mapping of various Schemes addressing malnutrition
• Outcome oriented by real time tracking
– Incentives (to states, districts, PRIs) based on outcomes
• Data collection and monitoring
– Incentivizing Anganwadi Workers for using IT tools
– ICT based Real Time Monitoring system (PMO every 6 months)
• Coordination b/w different levels
– National Council for Nutrition under NITI Aayog
– Executive Committee of Secretaries
– Convergence Action Plan at State, District and Block level
• Geographical convergence via Aspirational Districts Program
• Social Audits + Jan Andolan
Q3. How to make National Nutrition Mission a success?
 Policy interventions
• Strengthen and restructure ICDS
• Extend coverage of food fortification
– Currently only iodization of salt is mandatory
– Salt can be double fortified (Iodine + Iron)
– Make fortification of edible oils mandatory
• Target multiple contributing factors like WASH
• Align agricultural policy with nutritional objectives
– Incentives for producing nutrient rich and local crops
• Boost private sector engagement by PPPs
 Ideas by Swaminathan
• Move from Food Security to Nutrition Security
– Access to balanced diet, drinking water, sanitation and primary
healthcare
• Food based approach to nutrition security not drug based
– Include millets in addition to rice and wheat
– Increase consumption of milk and poultry
• Organize National Nutrition Week -> nutrition literacy
• National Grid of Genetic Garden of Bio-fortified Plants
• Improved post-harvest management to ensure food safety
• Develop a cadre of Community Hunger Fighters
 To summarize
• 50% of (< 5) children are nutritionally insecure
• First 1000 days are very crucial!!! – WHO
 MCQ #1
What is hidden hunger?
A. Micronutrient deficiency
B. Lack of clean drinking water
C. Macronutrient deficiency
D. Lack of proper sanitation
Q4. Discuss the challenges in achieving financial inclusion.
 History
• 1904 – Cooperative Credit Societies Act
• 1955 – nationalization of SBI
• 1969 – 14 private sector banks nationalized
• 1972 – Priority Sector Lending
• 1980 – 8 private sector banks nationalized
• Post-1990 reforms:
– SHG Bank Linkage Program
– Easing of KYC norms
– NPS-Lite + KCC + NREGS
• Current government:
– PM Jan Dhan Yojana + PMJJBY + MUDRA + APY
 Current Status
• Mar 2014 => there were 123 Cr accounts
• Apr 2018 => 31 Cr new bank accounts (PMJDY)
– 60% are in rural areas
– 50% are of women
 Challenges
• Inoperative accounts
• Impediments in Digitization
– English literacy is less than 10%
– 30% pop. is BPL and 90% in informal sector
– Cyber security + Skilled manpower to run systems
– High cost of taking infra to remote corners of the country
• Demand-side factors
– Lower income or asset holdings
– Awareness + Accessibility + Affordability
Way forward
 MCQ #2
Which organization initiated SHG Bank Linkage
Program?
A. NABARD
B. RBI
C. MUDRA
D. SIDBI
Q5. What steps has government taken to expand health coverage?
 Laws & Policies
• National Health Policy 2017 – after 15 years
• Mental Healthcare Act 2017
• HIV & AIDS Act 2017
• Indian Medical Council Act 1956 – amended
• Rights of PwD Act 2016
Overarching Program
 Maternal Health
• PM Surakshit Matritva Abhiyan – checkup on 9th of every month
• PM Matritva Vandana Yojana – Rs. 5000 in 3 installments
• Janani Suraksha Yojana – Rs. 1400 for institutional delivery
• Janani Shishu Suraksha Karyakram – free delivery + infant care
• Laqshya – Labour Room Quality Improvement Initiative
• Mothers’ Absolute Affection (MAA) Program – for breastfeeding
• National Nutrition Mission (NNM) - (0-6 yrs + PLM)
• Stree Swabhiman – promote menstrual hygiene through CSCs
 Child health
• Janani Shishu Suraksha Karyakram (JSSK) – infant care till 30 days
• Vatsalya – Maatri Amrit Kosh
• Rashtriya Bal Swasthya Karyakram – 4Ds – from 0-18 yrs age
• Rashtriya Kishor Swasthya Karyakram (10-19 yrs age)
• PM Overarching Scheme for Holistic Nutrition Abhiyaan (POSHAN)
• Project Dhoop – shift assembly time in schools to absorb sunshine
• Universal Immunization Programme
National Health Protection Scheme
• 5 L insurance cover per family per year for secondary/tertiary care;
• States to pay 40% cost;
• Implementation through State/District Health Agency
• At least 1 Medical College for every 3 Parliamentary Constituencies
• At least 1 Government Medical College in each State of the country
• Subsumes: RSBY + Senior Citizen Health Insurance Scheme (SCHIS)
 Disease targeted
• PM National Dialysis Program
• Revised National TB Control Program
– Rs. 500 per month for nutrition
• National AIDS Control Program
– Test & Treat Policy
– Mission Sampark
 Family Planning
• Mission Parivar Vikas – for access to contraceptives
• Nayi Pehel – family planning kit to newlyweds by ASHA
• Saas Bahu Sammelan
 Health Physical & Digital Infra
• PM Swasthya Suraksha Yojana – setup AIIMS
• Health & Wellness Centres (under Ayushman)
• PM Bhartiya Janaushadhi Pariyojana (PMBJP)
• Electronic Health Records System
• Mother & Child Tracking System
• ANM on Line (ANMOL)
• TB Patient Monitoring System (Nikshay)
• Mera Aspataal – rating portal
 MCQ #3
Project Sunrise pertains to which health
problem?
A. Vitamin D deficiency
B. HIV AIDS
C. Tuberculosis
D. Night Blindness
Q6. Discuss the initiatives to boost infrastructure in India.
 Urban Development & Housing
• Smart Cities
• AMRUT
• HRIDAY
• Housing for All (Urban) (refer July Yojana)
• Affordable Housing Fund with NHB
 Transport Infrastructure
• Indian Railways
– 7 Missions under Avtaran
– Dedicated Freight Corridors
– Mass Rapid Transit System – Metros, Suburban rails
• Bharatmala Pariyojana + Char Dham + Setu Bharatam
• Jal Marg Vikas Project
• Sagarmala Project
• UDAN + Nextgen Airports For Bharat (NABH) Nirman
• PM Urja Ganga project – Gas Grid
 Where is the money….50 trillion?
• National Investment and Infrastructure Fund
• Road & Infrastructure Cess
– Rs. 8 per Litre on imported petrol & diesel
• Real Estate Investment Trust
• Infrastructure Investment Trust
• Innovative PPP Models like TOT
• Indian Railway Finance Corporation (IRFC) bonds
Q7. Discuss the steps taken for social inclusion.

• Refer Yojana Discussion August 2018

 Thank You
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